Nursing Profession is Rife with Occupational Hazards

Nurses in emergency departments and other health care settings continue to report high levels of job-related injury, illness and assault, according to a pair of recent studies on nurse safety.

The vast majority of nurses experience—and work through—persistent job-related pain, according to a 2011 survey on nurse safety by the American Nurses Association (ANA). And that’s the least of it; nurses also reported pulled muscles, inadvertent (and sometimes life-threatening) needle pricks, and verbal and physical assault by patients, the survey found.

Emergency department nurses, meanwhile, continue to experience high rates of on-the-job violence, according to a 2011 study by the Emergency Nurses Association (ENA). More than half of nurses (53.4 percent) reported experiencing verbal abuse and more than one in 10 (12.9 percent) reported experiencing physical violence. The survey found no decrease in physical abuse or verbal assault of emergency department nurses between May 2009 and January 2011.

Nurses are at greater risk for assault because they spend more time with patients and patients’ families than other medical professionals, says Jacquelyn Campbell, PhD, RN, FAAN, program director of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program, and the Anna D. Wolf Chair and a professor at the Johns Hopkins University School of Nursing.

“I don’t think our systems—nursing professional systems, nursing education, hospital patient care systems—are as conscious of this issue as they should be,” says Campbell, the lead author of a study, published in the January 2011 issue of the Journal of Occupational and Environmental Medicine that found that almost one-third of nurses (30 percent) and nursing personnel experience physical or psychological workplace violence. Workplace violence was more likely to be reported by nurses working in emergency departments and psychiatric units, and with adolescents and cognitively impaired elderly patients, she found.

Overall, Workplace Conditions Improve

The good news? The ANA survey found promising changes in nurses’ work environments in the last decade, including greater access to patient lifting and transfer devices and more use of safe needle devices.

Violence against nurses is also on the decline, but it remains a growing concern; some 34 percent of ANA survey respondents expressed concern over on-the-job assault, up from 25 percent in 2001.

Nurses’ top concerns, however, are the acute or chronic effects of stress and overwork (74 percent) and disabling musculoskeletal injuries (62 percent)—and for good reason. The ANA survey found that nearly all of the more than 4,000 respondents reported neck, back or shoulder pain caused by the job, and 80 percent said it was a frequent problem. Thirteen percent of respondents reported at least three work-related injuries over the course of a year on the job.

Contracting infectious diseases also ranked as a major concern, and nursing organizations across the country are taking steps to protect nurses and other health care workers from contracting bloodborne diseases from needle pricks.

“Needlestick injuries are preventable and cannot be tolerated as a cost of doing business,” ANA President Karen A. Daley, PhD, MPH, RN, said in a news release. “Health care organizations are charged with ensuring safety and preventing harm—to patients, employees and the public.”

The ANA and other organizations have issued a “call to action” to help prevent needlestick injuries. In addition to addressing gaps in available safety devices, the call to action includes involving front-line workers in the selection of safety devices and enhancing worker education and training. More than a dozen nursing organizations endorsed the consensus statement.

Meanwhile, academic institutions and health care organizations are also taking steps to improve safety for nurses and other health care providers.

New Careers in Nursing scholar alumna Karen Jennings, MS, RN, PMHNP-BC, says she learned a lot about job safety while earning her degree last year from the Boston College William F. Connell School of Nursing. “My education and clinical experiences prepared me to use basic nursing safety skills throughout my work day,” she says. “I think the hospital has also established efficient safety guidelines and practices, and I know my colleagues and I are conscious of being safe in every interaction with staff and patients. It’s not something I worry about, but I’m definitely mindful of being safe on the job.”

Her current employer, McLean Hospital in Belmont, Mass., has taken steps to make a safer work environment for nurses, Jennings says. The hospital provides safe needle devices and red sharps boxes in all units and requires employees who are injured on the job or experiencing pain to be assessed by the hospital’s department of occupational health services. She and her colleagues are also required to complete annual training in occupational health and injury policy compliance. Still, Jennings knows colleagues who have been injured on the job.

The ENA study also found that hospitals were taking some positive steps to reduce assault. Although the rates of abuse did not decline from the previous year’s study, ENA found promising indicators in hospital reporting policies. Hospitals that placed higher emphasis on safety and reporting policies, particularly those with “zero tolerance” policies, had lower rates of physical and verbal abuse.

“Violence in our emergency departments affects not only nurses, other health care providers and emergency department staff, it puts the safety and well-being of our patients at risk,” AnnMarie Papa, DNP, RN, CEN, past president of ENA, said in a news release.

“We need hospitals and hospital administrators to take steps now to increase the safety of their emergency departments so that patients can receive the care they need. Zero-tolerance policies are showing great promise for reducing the incidence of violence, and we would like to see more hospitals implement these policies in order to safeguard patients’ safety and health, as well as that of the people who care for them.”

Safety practices, however, should start in nursing education, Campbell says.

While most violence was perpetrated by patients, a significant number of reported incidents were committed by patients’ families, she found in her study of workplace violence. Nursing education often doesn’t teach strategies to deal with patient families, Campbell says, or whom to enlist for help when a family member is showing aggression or signs of potential violence.

Discussions of workplace violence are incorporated in psychiatric and mental health nursing curricula, but all students should graduate with “the full spectrum of education around workplace violence,” she says. “They should know all the places they might encounter it and its long-term effects. I think we have to work on this from a number of different angles so we have a better system and a more proactive response to workplace violence.”

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